scholarly journals Decompressive craniectomy for malignant middle cerebral artery territory infarct: an institutional experience

2020 ◽  
Vol 7 (8) ◽  
pp. 2506
Author(s):  
Ranjit Kumar ◽  
Brijesh Kumar Tiwari ◽  
Sanjeev Kumar Pandey
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Term Outcome ◽  
Focal Neurological Deficit ◽  
Effective Measure ◽  
Long Term Outcome ◽  
Mortality And Morbidity ◽  
One Year

Background: Decompressive craniectomy is the surgical procedure to reduce intracranial pressure, refractory to medical measures. We have described our experience associated with the clinical profile, radiological profile, postoperative status and long term outcome in patients with malignant middle cerebral artery (MCA) territory infarct.Methods: Data were collected from patients who underwent hemispheric decompressive craniectomy for malignant MCA territory infarct in our hospital from May 2014 to June 2019. Clinical, radiological, surgical profile and long term outcome were studied.Results: There were a total of 51 patients aged between 28 years to 76 years. Hypertension (70%) was the most common comorbidity associated. All the patients had at least one focal neurological deficit at the time of presentation. Mean time from the first symptoms to surgery was 2.4 days (about 58 hours). 7 patients died within one month of the surgery. Two third improved objectively within 1 month of surgery. Out of 44 patients, who survived beyond one month, none of the patients were functionally independent after one year of surgery (modified Rankin scale (mRS) of 0 or 1). The patients had a mean mRS of 3.8 at one year.Conclusions: Over several decades decompressive craniectomy has been found to be the most effective measure to reduce mortality and morbidity associated with malignant MCA territory infarct. Early surgery (<48 hours) in patients with good Glasgow Coma scale score reduces the mortality. Larger multicentric trials are required to look at the long term effect on morbidity and mortality.

scholarly journals Predicting the Long-Term Outcome after Subacute Stroke within the Middle Cerebral Artery Territory

2005 ◽  
Vol 1 (2) ◽  
pp. 148 ◽  
Author(s):  
Oh Young Bang ◽  
Hee Young Park ◽  
Jung Han Yoon ◽  
Seung Hyeon Yeo ◽  
Ji Won Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Subacute Stroke

Impact of infections on long-term outcome after severe middle cerebral artery infarction

2012 ◽  
Vol 319 (1-2) ◽  
pp. 15-17 ◽  
Author(s):  
Lena Ulm ◽  
Hendrik Harms ◽  
Stephanie Ohlraun ◽  
Peter Reimnitz ◽  
Andreas Meisel
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Infarction ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Long-term outcome of balloon angioplasty without stenting for symptomatic middle cerebral artery stenosis

Nosotchu ◽  
2009 ◽  
Vol 31 (6) ◽  
pp. 544-549
Author(s):  
Toshihiro Ueda ◽  
Shinya Fukumoto ◽  
Masahiko Tagawa ◽  
Shinji Nogoshi ◽  
Ryuko Kurita ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Balloon Angioplasty ◽  
Artery Stenosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Middle Cerebral Artery Stenosis

Abstract T P289: Long-term Outcome Analysis in Patients With Malignant Middle Cerebral Artery Stroke Who Underwent Decompressive Hemicraniectomy

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jindong Xu ◽  
Sonisha A Warren ◽  
Anna Y Khanna
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Depression Scale ◽  
Functional Evaluation ◽  
Stroke Patients ◽  
Term Outcome ◽  
Cerebral Vessel ◽  
Long Term Outcome ◽  
Decompressive Hemicraniectomy

Background and Purpose: Decompressive hemicraniectomy (DHC) reduces mortality and improves physical outcome in selected patients with malignant middle cerebral artery (mMCA) stroke. In this study, we performed comprehensive functional evaluation in mMCA stroke patients who underwent DHC, and attempted to identify the pre-surgical factors that correlated with long-term physical outcome. Methods: We identified mMCA stroke patients treated with DHC in our institution between January 2007 and April 2013. Functional outcome was assessed in survivors through clinic visit or telephone interview using modified Rankin Scale (mRS), Barthel Index, Geriatric Depression Scale, Stroke Impact Scale, Satisfaction of Life Scale, and retrospective consent. In addition, all patients including survivors and deceased were classified into acceptable outcome (mRS<=4) and bad outcome (mRS>4) groups. Pre-surgical factors including age, gender, stroke risk factors, time to surgery, cerebral vessel involvement, cause of stroke, use of intravenous tPA or endovascular intervention were compared between two groups. Results: 37 patients were identified meeting our study criteria. 11 out of 16 survivors were enrolled for functional assessment (mean age 54.7 years, 73% male, 27% left hemisphere stroke, and mean time after stroke 3.4 years). Psychosocial aspect scored much higher than physical outcome in comprehensive functional evaluation. The majority of participants were satisfied with life and agreed for the retrospective consent. Comparing two groups with acceptable (n=9) and bad (n=23) outcomes, pre-surgical characteristics including age>60, anterior cerebral artery involvement, hemorrhagic transformation, history of diabetes and coronary artery diseases were potentially associated with worse long-term outcome. Conclusions: A better psychological recovery suggests that appropriate mMCA stroke patients should not be deprived a DHC only based on a presumed unfavorable physical outcome. Some pre-surgical factors may be predictive for a worse outcome, which will assist physicians and families making critical decisions.

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